me-day prescribing with opioids and benzodiazepines may put patients at increased risk of harm.The therapeutic alliance is a framework from psychology that describes three components goals, tasks, and bond. The Working Alliance Inventory adapted for general practice (WAI-GP) measures the strength of the therapeutic alliance between the patient and the clinician, and it could be useful in both research and clinical settings.
To determine if the patient score on WAI-GP can delineate the three components (goals, tasks, and bond), and to test concurrent validity with the Consultation and Relational Empathy (CARE) measure and the Patient Perception of Patient-Centredness (PPPC) measure.
A cross-sectional study took place in 12 general practice waiting rooms in Australia.
The research instruments included the 12-item WAI-GP (the patient version), the CARE and PPPC measures, plus a survey of demographics and reason for consultation. To perform a principal components factor analysis of the WAI-GP, this dataset was combined with an existing dataset. The Spearman rank correlation was used to determine comore specific feedback to clinicians on their consultation practices.Clinical guidelines recommend specific targets for low-density lipoprotein cholesterol (LDL-C) and non-high-density lipoprotein cholesterol (non-HDL-C) for primary prevention of cardiovascular disease (CVD). Furthermore, individual variability in lipid response to statin therapy requires assessment of the association in diverse populations.
To assess whether lower concentrations of LDL-C and non-HDL-C are associated with a reduced risk of major adverse cardiovascular events (MACE) in primary prevention of CVD.
An international, new-user, cohort study will be undertaken. It will use data from three electronic health record databases from three global regions Clinical Practice Research Datalink, UK; PREDICT-CVD, New Zealand (NZ); and the Clinical Data and Analysis Reporting System, Hong Kong (HK).
New statin users without a history of atherosclerotic CVD, heart failure, or chronic kidney disease, with baseline and follow-up lipid levels will be eligible for inclusion. Patients will be classified according to LDL-C (&lt;1.4, 1.4-1.7, 1.8-2.5, and ?2.6 mmol/l) and non-HDL-C (&lt;2.2, 2.2-2.5, 2.6-3.3, and ?3.4 mmol/l) concentrations 24 months after initiating statin therapy. The primary outcome of interest is MACE, defined as the first occurrence of coronary heart disease, stroke, or cardiovascular death. Secondary outcomes include all-cause mortality and the individual components of MACE. Sensitivity analyses will be conducted using lipid levels at 3 and 12 months after starting statin therapy.
Results will inform clinicians about the benefits of achieving guideline recommended concentrations of LDL-C for primary prevention of CVD.
Results will inform clinicians about the benefits of achieving guideline recommended concentrations of LDL-C for primary prevention of CVD.Shared decision making (SDM) is considered important to realise personalised cancer care. Increased GP involvement after a diagnosis is advocated to improve SDM.
To explore whether patients with cancer are in need of GP involvement in cancer care in general and in SDM, and whether GP involvement occurs.
An online national survey was distributed by the Dutch Federation of Cancer Patient Organisations (NFK) in May 2019.
The survey was sent to (former) patients with cancer. Topics included GP involvement in cancer care in general and in SDM. Descriptive statistics and quotes were used.
Among 4763 (former) patients with cancer, 59% (= 2804) expressed a need for GP involvement in cancer care. Of these patients, 79% (= 2193) experienced GP involvement. Regarding GP involvement in SDM, 82% of patients (= 3724) expressed that the GP should 'listen to patients' worries and considerations', 69% (= 3130) to 'check patients' understanding of information', 66% (= 3006) to 'discuss patients' priorities in life and the consequences of treatment options for these priorities', and 67% (= 3045) to 'create awareness of the patient's role in the decision making'. This happened in 47%, 17%, 15% and 10% of these patients, respectively.
The majority of (former) patients with cancer expressed a need for active GP involvement in cancer care. GP support in the fundamental SDM steps is presently insufficient. https://www.selleckchem.com/ Therefore, GPs should be made aware of these needs and enabled to support their patients with cancer in SDM.
The majority of (former) patients with cancer expressed a need for active GP involvement in cancer care. GP support in the fundamental SDM steps is presently insufficient. Therefore, GPs should be made aware of these needs and enabled to support their patients with cancer in SDM.In the Netherlands during the past decade, a growing number of people with dementia requested euthanasia, and each year more of such requests were granted.
To obtain quantitative insights into the problems and needs of GPs when confronted with a euthanasia request by a person with dementia.
A concept survey was composed for GPs in the Netherlands. Expert validity of the survey was achieved through pilot testing.
A postal survey was sent to a random sample of 900 Dutch GPs, regardless of their opinion on, or practical experience with, euthanasia. Collected data were analysed with descriptive statistics.
Of 894 GPs, 423 (47.3%) completed the survey, of whom 176 (41.6%) had experience with euthanasia requests from people with dementia. Emotional burden was reported most frequently (= 86; 52.8%), as well as feeling uncertain about the mental competence of the person with dementia (= 77; 47.2%), pressure by relatives (= 70; 42.9%) or the person with dementia (= 56; 34.4%), and uncertainty aboraining on end-of-life care needs of patients with dementia and their caregivers.Over the past 20 years prescription of opioid medicines has markedly increased in the UK, despite a lack of supporting evidence for use in commonly occurring, painful conditions. Prescribing is often monitored by counting numbers of prescriptions dispensed, but this may not provide an accurate picture of clinical practice.
To use an estimated oral morphine equivalent (OMEQ) dose to describe trends in opioid prescribing in non-cancer pain, and explore if opioid burden differed by deprivation status.
A retrospective cohort study using cross-sectional and longitudinal trend analyses of opioid prescribing data from Welsh Primary Care General Practices (PCGP) took place. Data were used from the Secure Anonymised Information Linkage (SAIL) databank.
An OMEQmeasure was developed and used to describe trends in opioid burden over the study period. OMEQburden was stratified by eight drug groups, which was based on usage and deprivation.
An estimated 643 436 843 milligrams (mg) OMEQwas issued during the study.